Request for a Place in the Nursery

REGISTRATION FORM

(Request for a Place in the Nursery)

1.Surname of your child:………………………………………………….………………..……………………………

First Names: ………………………………………………………………………………….……………………………...

(Please underline the name generally used)

Date of Birth:………….. Nationality: …………... Religion:……..………..Ethnicity: ……………

Proposed term and year of entry: …………………………….

Which school is your child registered for at 4+? ...... …………………………………………

…………………………………………………………………………………………………………………………………..…….

2. Father’s Title & Full Name:…………………………………………………………………………………………

Address: ………………………………………………………………………………………………………………..………

…………………………………………………….………………………………………. Post Code: ………………………..

Daytime Telephone: ……………………………Evening Telephone:………………………………………….

Email address: …………………………………… Occupation:………………………….….. ……………………

3.Mother’s Title & Full Name: …………………………………………………………………………………………

Address (if different from the above) …………………………………….……..………………………..…………

…………………………………………………….………………………………………. Post Code: ………………………..

Daytime Telephone: ……………………………Evening Telephone: ……….……………..………………….

Email address: …………………………………… Occupation: ………………….. ……………………..…………

4.Please mention here the names of any other members of the family attendingKing’s HouseSchool or registered for entry; or any other connection with the School.

……………………………………………………………………………….………………………………………………………

5.Please say how you first heard of the School. Was it from:

 Local Reputation PresentSchool Friends

 Advertisement Other (Please give details)

6.Please provide us with details of any medical condition (including allergies), disabilities or learning difficulties of your child

…………………………………………………………………………………………………………….………………………………

………………………………………………………………………………………………………………………………………………

Declaration: We request that the name of our above-named child be registered as a prospective pupil. A cheque for the non-returnable registration fee of £100 is enclosed. We understand that the terms and conditions of the School will undergo reasonable changes from time to time as circumstances require and will apply in all our dealings with the School. We understand also that the School (through the Head, as the person responsible) may obtain, process and hold personal information about our child, including sensitive information such as medical details, and we consent to this for the purposes of assessment and, if a place is later offered, in order to safeguard and promote the welfare of the child.

First Signature: …………..…………………….…….Second Signature:…………………………………….

Name in full:………………………………………….Name in full:…………………...…………………………….

Relationship to the Child: ……………………………Date: ……………………………

Account Name: King’s House School Account Number: 00349215 Sort Code: 30-97-06

Reference: REG followed by child’s full name

King's House School Trust (Richmond) Limited: a company limited by guarantee

Registered in England No: 00590559

Registered Office: 68 King's Road, Richmond, Surrey, TW10 6ES

Registered Charity No: 312669